Cancer Care Ontario Colonoscopy Standards: Standards and Evidentiary Base

Abstract

Colorectal cancer (CRC) is the most common cause of non-tobacco-related cancer deaths in Canadian men and women, accounting for 10% of all cancer deaths. An estimated 7800 men and women will be diagnosed with CRC, and 3250 will die from the disease in Ontario in 2007. Given that CRC incidence and mortality rates in Ontario are among the highest in the world, the best opportunity to reduce this burden of disease would be through screening. The present report describes the findings and recommendations of Cancer Care Ontario's Colonoscopy Standards Expert Panel, which was convened in March 2006 by the Program in Evidence-Based Care. The recommendations will form the basis of the quality assurance program for colonoscopy delivered in support of Ontario's CRC screening program.

The Quality of Screening Colonoscopies in an Office-Based Endoscopy Clinic

“…Because the OEC is a new institution, comment on the potential for missed adenomas (and cancer) cannot be made at this time. However, the best reassurance in this circumstance would be the better than average adenoma detection rate of 25.47% of all patients and polyp detection rate of 46.11% in a population with an average patient age of 57.1 years (8,13,20). Similar to previous publications, the present study confirmed an increasing adenoma detection rate with advancing age ( Table 5).…”

“…The routine practice at the OEC is to intubate the terminal ileum to confirm cecal intubation, and photo documentation of the ileum and cecal pole results in a reproducible and formal proof of a complete examination. The 98.98% cecal intubation rates achieved at the OEC are at least comparable with previous studies of in-hospital and academic institution procedures (8).…”

“…Table 1 presents a comparison of the OEC data with published benchmarks for quality colonoscopy and similar case series. The mean cecal intubation rate of 98.98% at the OEC is higher than the 95% rate recommended by CCO (8), the 95% recommended by the CPSO (14), the 90% recommended by the Joint Advisory Group on Gastrointestinal Endoscopy from the United Kingdom (15), and the 90% to 95% recommended by the US Multi-Society Task Force on Colorectal Cancer (16).…”

“…The 2007 CCO colonoscopy guidelines (8) were used as the main comparative benchmarks for the OEC data. The OEC data were also compared with other published guidelines and case series with similar populations (9-16) ( Table 1).…”

“…The average sedation dose of 4.27 mg of midazolam and 99.20 µg of fentanyl is similar to that routinely used in hospital practice, and ensures patient comfort and safety (17,18). The unit has the full capacity of a level II endoscopy centre as described by the CCO Colonoscopy Standards document (8).…”